脑肿瘤和转移瘤患者的癫痫持续状态：一项对208例患者的多中心队列研究及文献综述

Status epilepticus in patients with brain tumors and metastases: A multicenter cohort study of 208 patients and literature review.

作者信息

Rickel Johanna K, Zeeb Daria, Knake Susanne, Urban Hans, Konczalla Jürgen, Weber Katharina J, Zeiner Pia S, Pagenstecher Axel, Hattingen Elke, Kemmling André, Fokas Emmanouil, Adeberg Sebastian, Wolff Robert, Sebastian Martin, Rusch Tillmann, Ronellenfitsch Michael W, Menzler Katja, Habermehl Lena, Möller Leona, Czabanka Marcus, Nimsky Christopher, Timmermann Lars, Grefkes Christian, Steinbach Joachim P, Rosenow Felix, Kämppi Leena, Strzelczyk Adam

机构信息

Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University and University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany.

Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt, Germany.

出版信息

Neurol Res Pract. 2024 Apr 4;6(1):19. doi: 10.1186/s42466-024-00314-7.

DOI:10.1186/s42466-024-00314-7

PMID:38570823

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10993483/

Abstract

OBJECTIVE

Brain tumors and metastases account for approximately 10% of all status epilepticus (SE) cases. This study described the clinical characteristics, treatment, and short- and long-term outcomes of this population.

METHODS

This retrospective, multi-center cohort study analyzed all brain tumor patients treated for SE at the university hospitals of Frankfurt and Marburg between 2011 and 2017.

RESULTS

The 208 patients (mean 61.5 ± 14.7 years of age; 51% male) presented with adult-type diffuse gliomas (55.8%), metastatic entities (25.5%), intracranial extradural tumors (14.4%), or other tumors (4.3%). The radiological criteria for tumor progression were evidenced in 128 (61.5%) patients, while 57 (27.4%) were newly diagnosed with tumor at admission and 113 (54.3%) had refractory SE. The mean hospital length of stay (LOS) was 14.8 days (median 12.0, range 1-57), 171 (82.2%) patients required intensive care (mean LOS 8.9 days, median 5, range 1-46), and 44 (21.2%) were administered mechanical ventilation. All patients exhibited significant functional status decline (modified Rankin Scale) post-SE at discharge (p < 0.001). Mortality at discharge was 17.3% (n = 36), with the greatest occurring in patients with metastatic disease (26.4%, p = 0.031) and those that met the radiological criteria for tumor progression (25%, p < 0.001). Long-term mortality at one year (65.9%) was highest in those diagnosed with adult-type diffuse gliomas (68.1%) and metastatic disease (79.2%). Refractory status epilepticus cases showed lower survival rates than non-refractory SE patients (log-rank p = 0.02) and those with signs of tumor progression (log-rank p = 0.001).

CONCLUSIONS

SE occurrence contributed to a decline in functional status in all cases, regardless of tumor type, tumor progression status, and SE refractoriness, while long-term mortality was increased in those with malignant tumor entities, tumor progressions, and refractory SE. SE prevention may preserve functional status and improve survival in individuals with brain tumors.

摘要

目的

脑肿瘤和脑转移瘤约占所有癫痫持续状态（SE）病例的10%。本研究描述了该人群的临床特征、治疗以及短期和长期预后。

方法

本项回顾性多中心队列研究分析了2011年至2017年间在法兰克福和马尔堡大学医院接受SE治疗的所有脑肿瘤患者。

结果

208例患者（平均年龄61.5±14.7岁；51%为男性），所患疾病为成人型弥漫性胶质瘤（55.8%）、转移性肿瘤（25.5%）、颅内硬膜外肿瘤（14.4%）或其他肿瘤（4.3%）。128例（61.5%）患者有肿瘤进展的影像学标准，57例（27.4%）在入院时新诊断为肿瘤，113例（54.3%）患有难治性SE。平均住院时间（LOS）为14.8天（中位数12.0，范围1 - 57天），171例（82.2%）患者需要重症监护（平均LOS 8.9天，中位数5天，范围1 - 46天），44例（21.2%）接受了机械通气。所有患者出院时SE后功能状态均显著下降（改良Rankin量表）（p < 0.001）。出院时死亡率为17.3%（n = 36），转移性疾病患者死亡率最高（26.4%，p = 0.031），以及符合肿瘤进展影像学标准的患者死亡率最高（25%，p < 0.001）。一年时的长期死亡率（65.9%）在诊断为成人型弥漫性胶质瘤（68.1%）和转移性疾病（79.2%）的患者中最高。难治性癫痫持续状态患者的生存率低于非难治性SE患者（对数秩检验p = 0.02）和有肿瘤进展迹象的患者（对数秩检验p = 0.001）。